LNSRH對宮頸癌術(shù)后盆底功能及生活質(zhì)量的影響研究
發(fā)布時間：2019-01-08 08:12
【摘要】：背景宮頸癌是女性第二大惡性腫瘤,嚴(yán)重危害婦女健康。傳統(tǒng)廣泛性子宮切除術(shù)(radical hysterectomy,RH)聯(lián)合盆腔淋巴結(jié)清掃術(shù)是早期宮頸癌的主要手術(shù)方式,其5年生存率可超過80%。但RH在獲得療效的同時,損傷了盆腔自主神經(jīng),造成一系列盆底功能障礙并發(fā)癥,主要表現(xiàn)為膀胱,肛門直腸和性功能障礙,降低患者術(shù)后生活質(zhì)量。為了在延長生存期的同時,改善術(shù)后生活質(zhì)量,保留盆腔自主神經(jīng)廣泛性子宮切除術(shù)成為目前治療趨勢。由于腹腔鏡技術(shù)的獨特優(yōu)勢,特別是其放大視野作用,為術(shù)中神經(jīng)辨認(rèn)提供便捷,腹腔鏡下保留盆腔自主神經(jīng)廣泛性子宮切除術(shù)逐漸得到推廣。2008年保留盆腔自主神經(jīng)廣泛性子宮切除術(shù)正式列入了宮頸癌新的手術(shù)分級中。目的分析比較宮頸癌患者腹腔鏡下保留盆腔自主神經(jīng)廣泛性子宮切除術(shù)(laparoscopic nerve-sparing radical hysterectomy,LNSRH)及傳統(tǒng)腹腔鏡下廣泛性子宮切除術(shù)(laparoscopic radical hysterectomy,LRH)兩種術(shù)式術(shù)后盆底功能恢復(fù)及生活質(zhì)量情況,探討LNSRH對患者盆底功能及生活質(zhì)量的影響。方法收集2012年-2014年FIGO臨床分期為Ⅰb1~Ⅱa2期,于我院接受LNSRH(觀察組,138例)和LRH(對照組,138例)的宮頸癌患者臨床資料,進行回顧性隊列研究,觀察兩種手術(shù)對患者術(shù)后膀胱、直腸及性功能恢復(fù)的影響,綜合評價患者術(shù)后生活質(zhì)量情況。結(jié)果所有患者均順利完成手術(shù),兩組患者在術(shù)中出血量、淋巴結(jié)切除數(shù)目、陰道壁切除長度、手術(shù)時間、死亡率及復(fù)發(fā)率等方面比較差異均無統(tǒng)計學(xué)意義(P0.05),而LNSRH組術(shù)后住院時間較LRH組縮短(P0.05)。術(shù)后膀胱直腸功能恢復(fù)情況:LNSRH組留置尿管天數(shù)主要集中在7~14 d,而LRH組主要集中在15d,差異有統(tǒng)計學(xué)意義(P0.05);泌尿系統(tǒng)并發(fā)癥LNSRH組較LRH組減少(P0.05)。LNSRH組術(shù)后首次肛門排氣時間及排便時間均較LRH組縮短,且術(shù)后消化系統(tǒng)并發(fā)癥減少(P0.05)。LNSRH組術(shù)后I-QOL及PFIQ-7評分均優(yōu)于LRH組(P0.05)。術(shù)后性功能恢復(fù)情況:兩組患者術(shù)后性功能指數(shù)(FSFI)調(diào)查評分,術(shù)前兩組各個領(lǐng)域與總分無明顯差異(P0.05),術(shù)后LNSRH組在性欲望、主觀性喚起能力、性生活滿意度三個領(lǐng)域評分優(yōu)于LRH組(P0.05),在性活動時陰道潤滑性、性高潮及性交痛方面差異無統(tǒng)計學(xué)意義(P0.05)�？傇u分LNSRH組明顯優(yōu)于LRH組(P0.01)。術(shù)后生活質(zhì)量情況:兩組術(shù)后生活質(zhì)量簡易問卷(SF-36)評分情況,LNSRH組生理綜合(PCS)得分,心理綜合(MCS)得分及問卷總分均高于LRH組,差異有統(tǒng)計學(xué)意義(P0.01)。結(jié)論LNSRH作為早期宮頸癌手術(shù)治療方式是安全可行的,與LRH相比更有助于患者術(shù)后膀胱、直腸及性功能等盆底器官功能恢復(fù),并在一定程度上改善患者術(shù)后生活質(zhì)量。
[Abstract]:Background Cervical cancer is the second largest malignant tumor in women, which seriously endangers women's health. Conventional extensive hysterectomy (radical hysterectomy,RH) combined with pelvic lymph node dissection is the main surgical procedure for early cervical cancer, with a 5-year survival rate of more than 80%. At the same time, RH injured the pelvic autonomic nerve and caused a series of complications of pelvic floor dysfunction, mainly manifested as bladder, anorectal and sexual dysfunction, and reduced the postoperative quality of life of the patients. In order to prolong the survival time and improve the quality of life after operation, extensive hysterectomy with pelvic autonomic nerve preservation has become the current treatment trend. Because of the unique advantage of laparoscopic technique, especially its effect of magnifying the visual field, it is convenient to recognize the nerve during operation. Extensive hysterectomy with pelvic autonomic nerve preservation was gradually popularized under laparoscope. In 2008, pelvic autonomic nerve preserving extensive hysterectomy was officially included in the new surgical classification of cervical cancer. Objective to analyze and compare laparoscopic pelvic autonomic nerve preserving extensive hysterectomy (laparoscopic nerve-sparing radical hysterectomy,LNSRH) with conventional laparoscopic (laparoscopic radical hysterectomy, in patients with cervical cancer. To explore the effect of LNSRH on pelvic floor function and quality of life (QOL). Methods the clinical data of patients with cervical cancer receiving LNSRH (observation group, 138 cases) and LRH (control group, 138 cases) were collected from 2012 to 2014. To observe the effect of two kinds of operation on the recovery of bladder, rectum and sexual function, and to evaluate the quality of life after operation. Results all the patients completed the operation successfully. There was no significant difference in the amount of blood loss, the number of lymph nodes excision, the length of vaginal wall resection, the operative time, the mortality rate and the recurrence rate between the two groups (P0.05). The postoperative hospitalization time of LNSRH group was shorter than that of LRH group (P0.05). Postoperative recovery of bladder and rectum function: the days of indwelling urinary catheter in LNSRH group was 714 days, while that in LRH group was 15 days, the difference was statistically significant (P0.05). Urinary system complications in LNSRH group were shorter than those in LRH group (P0.05). The first anal exhaust time and defecation time in). LNSRH group were shorter than those in LRH group. Postoperative digestive system complications decreased (P0.05). LNSRH group, I-QOL and PFIQ-7 scores were better than LRH group (P0.05). Postoperative sexual function recovery: the (FSFI) score of postoperative sexual function index was not significantly different between the two groups before operation (P0.05), LNSRH group in sexual desire, subjective arousal ability, The score of sexual satisfaction in three areas was better than that in LRH group (P0.05), but there was no significant difference in vaginal lubricity, orgasm and sexual intercourse pain during sexual activity (P0.05). The total score of LNSRH group was significantly better than that of LRH group (P0.01). Quality of life (QOL): the score of simple questionnaire (SF-36) for postoperative quality of life in two groups, the score of comprehensive physiological (PCS), the score of psychological comprehensive (MCS) and the total score of questionnaire in LNSRH group were higher than those in LRH group, and the difference was statistically significant (P0.01). Conclusion LNSRH is safe and feasible as a surgical treatment for early cervical cancer. Compared with LRH, it is more helpful for the recovery of pelvic floor organ function, such as bladder, rectum and sexual function, and improves the postoperative quality of life to a certain extent.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33
本文編號：2404338
[Abstract]:Background Cervical cancer is the second largest malignant tumor in women, which seriously endangers women's health. Conventional extensive hysterectomy (radical hysterectomy,RH) combined with pelvic lymph node dissection is the main surgical procedure for early cervical cancer, with a 5-year survival rate of more than 80%. At the same time, RH injured the pelvic autonomic nerve and caused a series of complications of pelvic floor dysfunction, mainly manifested as bladder, anorectal and sexual dysfunction, and reduced the postoperative quality of life of the patients. In order to prolong the survival time and improve the quality of life after operation, extensive hysterectomy with pelvic autonomic nerve preservation has become the current treatment trend. Because of the unique advantage of laparoscopic technique, especially its effect of magnifying the visual field, it is convenient to recognize the nerve during operation. Extensive hysterectomy with pelvic autonomic nerve preservation was gradually popularized under laparoscope. In 2008, pelvic autonomic nerve preserving extensive hysterectomy was officially included in the new surgical classification of cervical cancer. Objective to analyze and compare laparoscopic pelvic autonomic nerve preserving extensive hysterectomy (laparoscopic nerve-sparing radical hysterectomy,LNSRH) with conventional laparoscopic (laparoscopic radical hysterectomy, in patients with cervical cancer. To explore the effect of LNSRH on pelvic floor function and quality of life (QOL). Methods the clinical data of patients with cervical cancer receiving LNSRH (observation group, 138 cases) and LRH (control group, 138 cases) were collected from 2012 to 2014. To observe the effect of two kinds of operation on the recovery of bladder, rectum and sexual function, and to evaluate the quality of life after operation. Results all the patients completed the operation successfully. There was no significant difference in the amount of blood loss, the number of lymph nodes excision, the length of vaginal wall resection, the operative time, the mortality rate and the recurrence rate between the two groups (P0.05). The postoperative hospitalization time of LNSRH group was shorter than that of LRH group (P0.05). Postoperative recovery of bladder and rectum function: the days of indwelling urinary catheter in LNSRH group was 714 days, while that in LRH group was 15 days, the difference was statistically significant (P0.05). Urinary system complications in LNSRH group were shorter than those in LRH group (P0.05). The first anal exhaust time and defecation time in). LNSRH group were shorter than those in LRH group. Postoperative digestive system complications decreased (P0.05). LNSRH group, I-QOL and PFIQ-7 scores were better than LRH group (P0.05). Postoperative sexual function recovery: the (FSFI) score of postoperative sexual function index was not significantly different between the two groups before operation (P0.05), LNSRH group in sexual desire, subjective arousal ability, The score of sexual satisfaction in three areas was better than that in LRH group (P0.05), but there was no significant difference in vaginal lubricity, orgasm and sexual intercourse pain during sexual activity (P0.05). The total score of LNSRH group was significantly better than that of LRH group (P0.01). Quality of life (QOL): the score of simple questionnaire (SF-36) for postoperative quality of life in two groups, the score of comprehensive physiological (PCS), the score of psychological comprehensive (MCS) and the total score of questionnaire in LNSRH group were higher than those in LRH group, and the difference was statistically significant (P0.01). Conclusion LNSRH is safe and feasible as a surgical treatment for early cervical cancer. Compared with LRH, it is more helpful for the recovery of pelvic floor organ function, such as bladder, rectum and sexual function, and improves the postoperative quality of life to a certain extent.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33
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